By Dr Kerry Allen (Lecturer in the Health Services Management Centre)
At a recent Centre for Ageing Better event Mind the Digital Gap an audience member spoke out against the ‘push’ for older people to be digitally literate and engaged. She explained that her plan for older age is to read all of the books she has amassed over the years and how unlikely she is to ever get through them all. The internet is surplus to her vision of a good retired life and what’s wrong with that? The panel and audience unanimously nodded their agreement. A clear message for policy and research, even from the strongest of advocates for digital technologies on the panel that day, was that - being online should never be seen as an outcome in itself and always as a means to an end.
An obvious question to ask about digitally-disinterested older people is - do they fully understand the benefits that being online might bring and how to achieve them in practice? Shifting the responsibility away from older people themselves, perhaps a more relevant question is - do health and social care policy makers, commissioners, providers and evaluators also fully understand these benefits and the support required to enable digital engagement? Another piece of the puzzle is whether the technology industry are incentivised to focus product design around older people and promote to these audiences.
Voice activated devices such as the Amazon Echo and Alexa have clear potential for frail and disabled older people. These web-enabled technologies can control smart household settings, provide diary reminders and respond to questions about weather, news, travel, local events etc. However, these gadgets are predominantly marketed as products for the assertive, young, professional, social and very, very busy. Beyond the general consumer market, digital technologies have a growing presence in health and social care interventions such as telehealth and telecare. The dominance of ‘a diverse provider market’ and of ‘choice’ in adult social care policies also suggests digital skills may become increasingly central to gaining access to and information about services.
Are older people digitally disinterested or digitally disheartened? Grandma Williams, an 82 year old blogger and panelist, indicates this important distinction that might be key to supporting the long term development of older people’s digital skills. In doing so she paints a vivid picture of what digital exclusion can feel like. In some cases people are genuinely supported by their family network and have no interest or need to develop ‘independent’ digital literacy skills. For others, such as the one in 14 people over 65 with dementia in the UK, many digital skills such as email and text messaging become unrealistic. More often though older people do recognise the benefits, but become disheartened by:
- fear of looking foolish
- uncertainty about how to use new products (will there be someone to ask?)
- confusing terminology that often redefines meanings for familiar words (e.g. spam, wallpaper, browsers, files, swiping and servers) or new words and acronyms that can simply baffle (e.g. Googling and the unGoogleable, WiFi, podcasts, GIFs and JPEGs)
- guidance that is incompatible to people’s learning style, ultimately weakening rather than enhancing digital confidence.
Findings from research led by James Richardson of Good Things Foundation was reported by The Centre for Ageing Better in their May 2018 report The digital age: new approaches to supporting people in later life get online. The report identifies eight key good-practice principles for delivering support which should be on the radar of those shaping local care strategies for older people, as well as delivering support:
- Flexibility and relevance: Structured courses focused on ‘developing skills’ are unlikely to be effective in improving self-efficacy or in generating and sustaining interest. Support should concentrate on helping people to do the things they need and want to do online.
- The right pace: Older learners will have differing abilities to pick up information and will progress their learning at different paces. It is important that support is responsive to the needs of the individual learner.
- Repetition and reflection: Creating space for repetition is essential in allowing people to consolidate learnings and build confidence in completing tasks. The opportunity to recognise and reflect on successes achieved should be central to all learning encounters.
- The right language: Overuse of technical terms can be confusing and counterproductive. Simple language should be used which focuses on the task being completed, rather than the technology they are using to do it.
- One-to-one support: A strong tutor-pupil relationship is key to building confidence, which is as important as developing specific skills and knowledge for older learners.
- Time to build relationships: Tutors who devote time to building communication and trust will be better able to maintain learners’ interest in digital and increase their self-efficacy.
- Ongoing support: Support needs to be ongoing and structured in an open-ended way, allowing learners to return with questions and problems.
- Co-design: It is essential to involve users in the shaping and design of all services, new and existing, to ensure their relevance and effectiveness. A wide range of current service users, along with people who aren’t currently engaged, should be involved.
Digital engagement in later life is not always desirable or possible and the provision of alternative information channels should always be good practice in health and care. However, of the 4.8 million people over 55 who are currently not online, many could experience preventative gains related to social interaction, better information, increased access to other services and enhanced self-management resources for long-term conditions and disabilities. Digital inclusion is a natural meeting point for health and social care; getting it right promises to improve the quality of older people’s lives as well as health system outcomes.
The scope for improvement is broad. People who use the internet now and again might discover much more fully how digital resources could enhance their unique situation, if support is provided in the right way. The existence and accessibility of digital technologies alone are unlikely to be enough to close the digital gap. The impact of cross-cutting structural variables such as gender, poverty and technology industry governance are worthy of greater research attention as this area of policy and practice takes shape.